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CP5 > DME > Flashcards

DME Flashcards

1
Q

What is approach in a ME?

A

ABCDE

Airway
Breathing
Circulation
Disability
Exposure

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2
Q

Why do ABCDE approach?

A
  • Needed to assess acute illness in pt
  • A decision procedure
  • Treat as you find
  • Cyclical reassessment
  • Systematic
  • Universal assessment tool
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3
Q

What approach would you use if pt is collapsed / unconscious?

A

DRS ABC

Danger
Response
Shout for help

Airway
Breathing
Circulation

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4
Q

How do you assess Airway? (3)

A

Initial observations
o Hoarse voice
o Itching / burning / difficulty swallowing
o Chest tightness
o Breathing difficulty

Aural inspection
o Wheeze / stridor / cough / snore / gurgle / shortness of breath / change in voice

Visual inspection
o Irritation around mouth
o Swelling of lips
o Injury e.g. a cut
o Foreign body in the mouth

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5
Q

How to assess Breathing? (3)

A
  • Pulse oximetry
  • Respiration rate
  • Peak expiratory flow
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6
Q

How to do pulse oximetry / what does it record? What can it be affected by?

A

Records:
- Pulse, in beats per minute
- Blood oxygen saturation, %

Reading can be affected by cold hands / movement / nail varnish

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7
Q

How to record respiration rate?
What is normal respiration rate (adult)?

A

Count rise and fall of pt chest for 30 seconds
Multiply by 2

Normal adult respiration rate: 12 – 20 breaths per minute
- Low when sleeping / high physical fitness
- High when exercising / emotional stress

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8
Q

How to measure peak expiratory flow?

A
  • Select correct size, smaller one for petite adults / children
  • Push pointer to zero
  • Pt standing or sitting upright
  • Pt should take deep breath in and blow as hard / fast as possible into the meter
  • Lips should be sealed around mouthpiece
  • Should be held horizontally
  • Record reading 3 x
  • Compare highest reading to pt best value in 2 years / against standard population values
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9
Q

How do you assess Circulation? (4)

A
  • Reported symptoms
  • Heart rate and rhythm
  • Capillary refill times
  • Blood pressure
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10
Q

Which reported symptoms should you ask about to assess Circulation?

A
  • Palpitations / chest pain - May indicate cardiac arrythmia / cardiac ischaemia / panic attack
  • Coldness / tingling of peripheries
  • Visual / auditory disturbance, dizziness, feeling faint / nausea
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11
Q

What is normal adult pulse rate?

A

60 - 100 bpm

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12
Q

How do you assess heart rate and rhythm?

A

Palpate radial pulse
- Place fingers on wrist
- Count beats in 30s then x2

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13
Q

When may you not be able to detect radial pulse? What should you do instead?

A
  • Pt with low BP
  • Palpate carotid pulse - place finger between trachea and sternocleidomastoid muscle - count beats in 30s then x2
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14
Q

When should you use capillary refill time? How to measure? What is normal CRT?

A
  • Crude measure when BP monitoring unavailable
  • Hold pt hand, pinch fingerer 5s see how long takes to return to normal colour
    < 2s
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15
Q

How to measure BP?

A
  • Ask pt to roll up sleeves
  • Place cuff above elbow joint directly on skin
  • Align with brachial artery mark
  • Secure cuff, explain to pt may feel tight while it inflates
  • Press start and record readings
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16
Q

Difference between systolic and diastolic BP?

A
  • Systolic measures force in heart contraction
  • Diastolic measures heart in relaxation
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17
Q

What is considered high and low systolic BP?

A

< 90 mmHg = critically low
91 – 100 mmHg = very low
101 – 110 mmHg = low
111 – 219mmHg = normal
> 220 mmHg = high

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18
Q

How to assess Disability? (3)

A
  • Capillary blood glucose
  • AVPU
  • Pain assessment
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19
Q

What is normal adult capillary blood glucose?

A

4 - 8 mmol / L

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20
Q

How to measure capillary blood glucose?

A

 Insert test strip into glucometer
 Obtain a pinprick blood sample from pt finger
 Dispose of sharps
 Apply blood droplet to test strip
 Dispose appropriately
 Record reading

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21
Q

What is AVPU?

A

Neurological assessment

Alert
Verbal - loud voice
Verbal - shouting
Pain - touch
Pain - shake
Pain - earlobe pinch
Unresponsive

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22
Q

How to carry out pain assessment?

A

SOCRATES

Site
Onset
Character
Radiating
Time
Exacerbating factors
Severity

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23
Q

How to assess exposure?

A

Visual inspection
- Should finalise assessment
- Needs pt consent

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24
Q

What is acute cardiac ischaemia essentially?

A

Reduced o2 flow to the heart

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25
Q

What are 2 causes of ACI?

A
  1. Stable angina
  2. Acute coronary syndrome ACS
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26
Q

What is stable angina?

A

Chronic condition caused by narrow coronary arteries

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27
Q

What 2 things does ACS describe?

A
  1. Myocardial infarction MI
  2. Unstable angina

More severe interruption of blood flow to the heart

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28
Q

What is unstable angina?

A

Deterioration without damage to heart muscle - chronic condition

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29
Q

Difference between ST and non ST elevation MI?

A

ST elevation MI - damage to heart muscle great enough to be seen in ST segment on ECG

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30
Q

How does stable angina differ at rest / in exertion?

A

At rest = normal blood flow, atheroma plaque on vessel wall reduces lumen size but still sufficient to meet O2 demand

Exertion / heightened emotion = increased O2 demand, lumen size not insufficient and symptoms of ischaemia

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31
Q

How does ACS differ at rest / in exertion?

A

At rest = larger atheroma plaque present – blood flow reduced – ischaemia without exertion / emotional triggers

Exertion = ischaemia symptoms greater

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32
Q

How does a clot form?

A

Atheroma creates narrow lumen which increases BP – pressure erodes atheroma plaque – causes bleeding and blood clot forms – occludes vessel more

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33
Q

Risk factors for ACS?

A

Diabetes
Hypertension
Obesity
Smoking

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34
Q

How does ACS present?

A
  • Chest pain
  • Radiation to arm, back, jaw
  • Shortness of breath
  • Nausea
  • Abdominal pain
  • Fatigue

Not all pts report chest pain (women, elderly, diabetics)

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35
Q

How can you differentiate between stable angina and ACS? Approaches?

A

ABCDE

THE DRS

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36
Q

What does THE DRS stand for?

A

Trigger
History
Episodes

Duration
Resolution
Severity

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37
Q

Use THE DRS to compare ACS with stable angina

A

Trigger - ACS unclear, SA obvious e.g. exertion/emotion

History - ACS none, SA known history chest pain

Episodes - ACS increased freq, SA no change in episode freq

Duration - ACS symptoms >15mins, SA resolves <15mins

Resolution - ACS slow response to GTN, SA may resolve with rest and fast response to GTN <4 activations

Severity - ACS worse than typical angina pain, SA typical pain

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38
Q

How to manage stable angina? (3)

A
  • Rest
  • GTN spray
  • Monitor and review ABCDE
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39
Q

How should you deliver GTN spray? Dosage?

A

Do not shake bottle - activate pump
Under tongue
1-2 sprays every 5 mins
Max 6 doses
If symptoms persist after 4 doses / longer than 15 mins call 999

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40
Q

How to manage ACS? (4)

A
  • GTN spray
  • Aspirin - single chewable tablet 300mg
  • o2
  • Monitor, review ABCDE
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41
Q

When should you use o2 to manage ACS?

A

Hypoxic pt
o2 sat <94%
Simple face mask 5-10 L/min
If high risk hypercapnia nasal cannula 4 L/min
If history COPD nasal cannula 1-2 L/min

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42
Q

What causes anaphylaxis?

A

Over release of histamines
Affects, airway, breathing and circulation
Life threatening hypersensitivity

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43
Q

Common alleges causing anaphylactic rxn?

A

Foods - nuts / eggs / shellfish
Insect stings - bees / wasps
Medication - Penicillin / NSAIDs
Materials - latex

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44
Q

Anaphylaxis - how is airway affected?

A

Visually - soft tissues swell e.g. tongue, soft palate
Auditory - stridor / wheeze / change of voice / coughing
C/O - itching / difficulty swallowing

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45
Q

Anaphylaxis - how is breathing affected?

A
  • High respiratory rate
  • Low o2 saturation <94%
  • Pt experience shortness of breath, runny nose, cough
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46
Q

What is normal adult o2 saturation - for low and high risk hypercapnia?

A

Low risk 94 - 98% o2 sat
High risk 88 - 92% o2 sat

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47
Q

When should you use PEF to assess breathing?

A

If you suspect asthma

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48
Q

Who should GTN not be given to?

A

Pts:
- Allergic to nitrate meds
- Hypotensive
- Mitral stenosis
- Pregnant
- On Viagra

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49
Q

Anaphylaxis - how is circulation affected?

A
  • High HR
  • Low BP
  • Pt experiences dizziness, visual disturbances, pale skin
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50
Q

Anaphylaxis - how is disability affected?

A
  • Reduced consciousness
  • Fatigue / confusion
  • Anxiety
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51
Q

Anaphylaxis - how is exposure affected?

A
  • Rash / flushed skin
  • Cyanosis - blueish skin
  • Angiodema - swellings
  • Cold peripheries / itching / sweat
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52
Q

How to manage anaphylaxis? (6)

A
  • Call 999
  • Remove trigger if possible
  • Semi recline pt and elevate legs
  • Give IM adrenaline
  • Give o2
  • Salbutamol
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53
Q

Dosages of IM adrenaline
<6 months
<6 years
6 - 12
Adult and child > 12 years

A

<6 months 100 - 150mg
<6 years 150mg
6 - 12 years 300mg
Adult and child > 12 years 500mg

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54
Q

What are different types of IM adrenaline?

A
  • Epi Pen
  • Ampoules
55
Q

How much o2 would you give in anaphylaxis? What type of face mask?

A

15 L/min via non-rebreather mask

56
Q

How would you give Salbutamol in anaphylaxis? What dosage?

A

Adapted technique using air spacer
2 puffs every 2 minutes
(Total of 10 over 10-20 minutes)

57
Q

What does the adapted technique involve?

A
  • Remove caps from spacer and inhaler
  • Shake inhaler
  • Insert mouthpiece into spacer
  • Ask pt to exhale
  • Apply face mask, ensure effective seal
  • Give 1 puff, ask pt to inhale
  • Ask pt to hold breath for 10s
58
Q

How would you prep for giving O2 for anaphylaxis?

A
  • Place finger over non rebreather mask valve
  • O2 should pump bag
  • Place mask over pt nose and mouth
  • Effective seal
  • Monitor O2 sats
59
Q

If not anaphylaxis - what other similar ME could it be? (3)

A

Asthma
ACI
Hyperventilation

60
Q

Define asthma

A

Long term respiratory condition
Chronic bronchial inflammation, increased mucus production and tissue oedema

61
Q

What are the 3 types of asthma?

A
  • Moderate
  • Acute severe
  • Life threatening
62
Q

How does asthma present?

A

Wheezing
Coughing
Breathlessness

63
Q

What should all suspected asthma pts be assumed to be prior to assessment?

A

Acute severe

64
Q

Airway - asthma?

A

Audible wheezing

65
Q

Breathing - asthma?

A

Increased respiratory rate
Reduced PEF
O2 sats <94%

66
Q

Circulation - asthma?

A

High HR
Arrhythmia - life threatening

67
Q

Disability - asthma?

A

Anxiety
Deteriorating conscious level - sometimes

68
Q

Exposure - asthma?

A

Cyanosis

69
Q

Difference in respiratory rate for mod / acute sev / life threat?

A

Mod - less than 25bpm
Acute sev - 25bpm +
Life threatening - 25bpm +

70
Q

Difference in HR for mod / acute sev / life threat?

A

Mod - less than 110bpm
Acute sev - 110bpm +
Life threatening - Arrhythmia

71
Q

Difference in O2 sats for mod / acute sev / life threat?

A

Mod - more than 92%
Acute sev - more than 92%
Life threatening - less than 92%

72
Q

Difference in PEF for mod / acute sev / life threat?

A

Mod - between 50-70%
Acute sev - between 33-50%
Life threatening - less than 33%

73
Q

Other differences between mod / acute sev / life threatening asthma?

A

Mod - speech normal
Acute sev - unable to complete full sentences
Life threatening - altered consciousness, cyanosis, poor respiratory effort

74
Q

When should you call 999 for asthma?
What should lower threshold to call 999?

A
  • Acute sev / life threatening on assessment
  • No improvement / worsening with tx
  • If 6 activations Salbutamol ineffective
  • Prev near-fatal asthma
  • Hospital admission for asthma in last 12 months
75
Q

How is asthma managed?

A

Salbutamol with spacer
O2 with simple face mask

76
Q

Dosage of salbutamol for asthma?

A

2 puffs every 2 minutes (total 10 in 10-20mins)
Mod - 2 immediately
Acute sev - 4 immediately
Life threatening - 6 immediately

77
Q

At what O2 sats do we start giving O2?

A

<94%

78
Q

What dose of O2 for asthma?

A

5-10 L/min via simple face mask
If pt COPD 1-2 L/min

79
Q

How do you record PEF?

A
  • Push bar back to zero
  • Sit pt up
  • Pt to make forced exhale
  • Record 3 best results
  • Compare best to pt norm
80
Q

If not asthma what other ME could it be?

A

Anaphylaxis
Acute cardiac ischaemia
Hyperventilation

81
Q

Which pts are low risk hypercapnia? Management?

A

Less than 94% O2 sats
Administer O2 5-10 L/min via simple face mask

82
Q

Which pts are high risk hypercapnia? Management?

A

Less than 88% O2 sats
Administer O2 1-2 L/min via nasal cannula

83
Q

When should you call 999 for asthma ME?

A

If pt acute severe / life threatening asthma
If 6 activations of salbutamol ineffective

84
Q

What is hyperventilation?

A

Stress response - psychological

85
Q

Airway - hyperventilation

A

Noisy breathing

86
Q

Breathing - hyperventilation

A

Increased respiratory rate / effort
Normal O2 sats

87
Q

What is a normal breathing rate range?

A

12 - 20 breaths per min

88
Q

What is normal heart rate range?

A

60 - 100 beats per min

89
Q

What is normal blood glucose range?

A

4 - 8 mmol/Hg

90
Q

Circulation - hyperventilation

A

High HR
Palpitations

91
Q

Disability - hyperventilation

A

Anxiety
Chest pain

92
Q

Exposure - hyperventilation

A

Blotchy rash
Muscle stiffness / spasm

93
Q

What 3As should be ruled out to identify tx as hyperventilation?

A

Asthma
ACI
Anaphylaxis

94
Q

How should hyperventilation be managed?

A
  • Remove stressor
  • Calm environment
  • Coach slow breathing
  • Reassess with ABCDE
  • Monitor then safe discharge
95
Q

What should you do if pt remains same / deteriorates after hyperventilation tx?

A

Reconsider 3As
Call 999

96
Q

What are breathing techniques you can coach pt through?

A
  • Through pursed lips
  • Offer water to naturally slow breathing
  • Abdominal breathing
  • Breathing through one nostril, alternating
97
Q

Which pts are at risk of hypoglycaemia?

A

Type 1 DM
Type 2 DM diet controlled
Type 2 DM insulin

98
Q

How is severity of hypoglycaemia assessed?

A

Behaviour and AVPU

99
Q

Use AVPU to give hypoglycaemia severity

A
  • Alert = conscious, can self help and swallow - MILD
  • Verbal = responds to voice, conscious but drowsy - MODERATE
  • Pain = responds to touch, unable to self help - MODERATE
  • Pain = responds to shaking, fitting / aggressive - SEVERE
  • Unresponsive = unconscious - SEVERE
100
Q

What are symptoms of hypoglycaemia?

A

Shaking
Sweating
Palpitations
Confusion
Aggression
Slurred speech
Loss of consciousness

101
Q

How to manage mild hypoglycaemia?

A

Quick acting carb and long acting carb
Glucose liquid and then biscuits

102
Q

How to manage moderate hypoglycaemia?

A

Quick acting carb
2 tubes glucose gel

103
Q

How to manage severe hypoglycaemia?

A

1mg glucagon, intramuscular / sub cut / intravenous
Call 999

104
Q

What determines hypoglycaemia?

A

CBG > 4mmol/L

105
Q

When should you repeat CBG?

A

After 15 mins and recategorise severity

106
Q

What should you do if following reassessment CBG less than 4?

A
  • Fast acting carb (glucose gel / liquid) max 3x
  • Until CBG more than 4
  • Then give complex carb (biscuits)
  • If CBG stays less than 4 after 3 fast acting carbs call 999
107
Q

What should you do if following reassessment CBG more than 4?

A
  • Give complex carb (biscuits)
  • Monitor until 2 CBGs recorded more than 4
  • Safe discharge
108
Q

When is glucose juice / tablets indicated?

A

Fast acting for mild hypoglycaemia - first line

109
Q

When is glucose gel indicated?

A

Fast acting for moderate hypoglycaemia - first line

110
Q

Which is best way to give glucagon injection according to NICE Guidelines?

A

Intramuscular

111
Q

How is glucagon hypo kit used?

A
  • Check allergies, dose and expiry date then open
  • Use pre filled syringe and inject 1.1ml water into vial
  • Shake until white powder is dissolved
  • Draw solution back into syringe
112
Q

How can you identify a seizure?

A

Loss of consciousness
Erratic muscular movement
Grunting noises

113
Q

How should you manage seizure in tonic phase?

A

Lay pt flat
Remove items e.g. phone, keys
Protect pts head
Note time

114
Q

How should you manage seizure in clonic phase?

A

15 L O2 non rebreather mask
Watch pt entire time

115
Q

How should you manage seizure in post-ictal phase?

A

Pt in recovery position
Remove O2 once start to come round
Perform ABCDE assessment

116
Q

What should you do if seizure is less than 5 mins and no injury is sustained?

A

Support and monitor the pt
Assess ABCDE and check CBG

117
Q

What should you do if seizure is more than 5 mins and pt has history of seizures?

A

Follow care plan
Or call 999
Then reassess ABCDE and check CBG

118
Q

What 3 occasions should you always call 999 if pt has had a seizure?

A
  • First ever seizure
  • Seizure recurs 3 times in an hour
  • Seizure less than 5 mins but pt known to have prolonged seizures
119
Q

How long do most tonic-clonic seizures last?

A

2 - 3 mins

120
Q

What is syncope?

A

Rapid loss of consciousness

121
Q

What are the red flags you should look out for? (7)

A

More than 4 mins
Poor recovery, remains drowsy
No warning signs
Recurring when upright again
Significant cardiac history
Cardiac symptoms - chest pain, palpitations
Syncope from supine

122
Q

How would you describe most syncope episodes in dental settings?

A

Benign
- Postural hypotension
- Vasovagal

123
Q

When should you call 999 for syncope?

A

Red flag identified
Injury sustained beyond first aid

124
Q

How should you manage syncope immediately?

A

Lay flat, elevate legs
Identify red flags and injuries

125
Q

How should you manage syncope if no red flags or injuries?

A

Move pt from flat into seated pt
Reassess
Monitor, safe discharge

126
Q

How can you elevate legs following syncope?

A

Curls legs into body
Legs on a chair

127
Q

When should you use non rebreather mask?

A

Anaphylaxis and seizure

128
Q

What O2 flow rate for non rebreather mask?

A

15 L/min

129
Q

When should you use nasal cannula?

A

High risk hypercapnia - O2 less than 88%

130
Q

What O2 flow rate for nasal cannula?

A

1 - 2 L/min

131
Q

When should you use a simple face mask?

A

O2 sats less than 94% hypoxic but low risk hypercapnia

132
Q

What O2 flow rate for simple face mask?

A

5 - 10 L/min

133
Q

If pt on simple face mask O2 sats drop below 85% how should you manage?

A

Give 15 L/min with non rebreather mask

CP5 (7 decks)

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